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General NPI Number Information
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NPI Number | 1770827776
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Entity Type | Individual
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Provider Name | ANNMARIE GREEN BOLDUC APRN
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 1617 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1040
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Country | US
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Telephone | 941-613-2400
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Fax | 941-613-2401
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Provider Business Mailing Address
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Address Line | 3322 PURPLE MARTIN DR UNIT 142
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City | PUNTA GORDA
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State | FL
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Zip | 33950-6746
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Country | US
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Telephone | 860-655-3395
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 005213
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 005213
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11015846
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License Number State | FL
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